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General NPI Number Information
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NPI Number | 1497446769
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Entity Type | Organization
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Legal Business Name | STILL WATERS WELLNESS LLC
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 301 S MAIN ST STE D
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City | CAVE CITY
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State | AR
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Zip | 72521-5010
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Country | US
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Telephone | 870-613-2354
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Fax |
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Provider Business Mailing Address
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Address Line | 301 S MAIN ST STE D
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City | CAVE CITY
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State | AR
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Zip | 72521-5010
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Country | US
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Telephone | 870-613-2354
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CARLA J SMITH
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Credential | APRN
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Telephone | 870-613-2354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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